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Here’s another reason not to smoke, if you’re a woman: PMS.

Women 27 to 44 years old who smoke are twice as likely to develop premenstrual syndrome over the next two to four years, especially hormonally-related symptoms like backaches, bloating, breast tenderness, and acne, Dr. Elizabeth R. Bertone-Johnson of the University of Massachusetts in Amherst and her colleagues found.

“Our findings lend further support to the idea that smoking increases the risk of moderate to severe PMS, and provides another reason for women, especially adolescents and young women, not to smoke,” Bertone-Johnson told.

Up to 20% of women have PMS severe enough to affect their relationships and interfere with their normal activities, Bertone-Johnson and her team note in the American Journal of Epidemiology.

Smoking has been shown to affect levels of several different hormones, and the handful of studies looking into PMS and smoking have suggested that women with the syndrome are more likely to be smokers, the researchers add.

To investigate the relationship further, they analyzed data from the Nurses’ Health Study II, which has been following 116,678 US registered nurses since 1989.

The researchers looked at a subset of women who were PMS-free during the first two years of the study, comparing 1,057 who did go on to develop PMS to 1,968 who did not.

Read more at Reuters